Please enter your full name (e.g. Mary LEE Smith, capitalizing maiden name)

Maiden Name, if applicable (e.g. LEE, all capitals)

Please indicate your connection with Yorktown High School 
(you can select more than one option by holding down the "shift" key while you make your selection)

Alumni Parent (or relative) of Yorktown Student Parent (or relative) of Yorktown Alumni Friend Yorktown Staff Other

If you are an alum, please enter your graduating class (e.g. 1984)

Street Address:

Address Line 2 (if applicable)

City

State

Zip code

Home Email Address:

Work Email Address

Home Phone: (e.g. 703-525-5555)

Home Fax: (e.g. 703-525-5555)

Employer: 

Occupation: 

Work Phone:  (e.g. 703-525-5555x243)

Work Fax:  (e.g. 703-525-5555)

Pager or Cell Phone (e.g. 703-525-5555)

Spouse's Name: (If applicable)

Spouse's Graduating Class (If applicable)

1.  Child's Name and DOB, If Applicable  (e.g. Lisa Smith 01/15/1990)

2. Child's Name and DOB (e.g. Lisa Smith 01/15/1990)

3. Child's Name and DOB (e.g. Lisa Smith 01/15/1990)

If you have more than 3 children, please list their names and DOB in the comments section.  Thanks!

Please mark the appropriate box to be included in your class mailing list:

I DO want to be included in my class mailing list
I DO NOT want to be included in my class mailing list

I would like more information about acting as my class mailing list moderator:

YES
NO

If you are interested in helping, please indicate your areas of interest:

Do you have any news to share in our newsletter?  If so, enter it in the text box here:

I want to pay my $10 annual dues by:

PayPal e-payment

PayPal - VISA

PayPal - MasterCard

I'll mail my Check payable to Alumni & Friends of Yorktown High School, Inc. to P.O. Box 7698, Arlington, VA. 22207. Please print your name while at Yorktown, & Graduating Class in the note section. Thanks.

PLEASE NOTE: If you pay by credit card, PayPal will ask you for your three (3) digit card verification number. These are the numbers following the credit card number, or last four numbers (depending of which card you're using)  on the signature strip on the back of the credit card.

Comments: 

(Or, if you, or any member of your family, will need special accommodations to participate in any of our activities due to a disability of any kind, please let us know what we can do to make participation most enjoyable)